Another Nail in the Low-Fat Coffin

Hot off the presses.

322 obese folks randomized to one of 3 diets for 2 years: Low-fat, Mediterranean or Low-Carb.

An amazing 84.6% adherence rate at 2 years!

The results?

Not spectacular in terms of actual amount of weight loss but significant in terms of who lost what.

3.3kg in 2 years for study completers in the low-fat group.

4.6kg in 2 years for study completers in the Mediterranean group

5.5kg in 2 years for study completers in the low-carb group.

Metabolic parameters were also better in the Mediterranean and low-carb groups versus low fat for cholesterol numbers, fasting insulin and glycemic control.

Bottom line?

Blindly low-fat diets do not appear to be as effective for weight loss OR for health as other dietary approaches.

National eating guidelines and guidelines from medical organizations need to start changing their recommendations and letting go of an outdated and now unsupported approach for the blanket reduction in dietary fat as either a means to improve health or weight loss.

It's my opinion that blindly low-fat diets, whether for weight-loss or for health, are dead horses as far as the evidence is concerned.

How much ya wanna bet people keep beating them?

The American Heart Association Gets It!

Or do they?

A few weeks ago, the American Heart Association released a position paper and call to action on the matter of obesity.

The paper, entitled "Population-Based Prevention of Obesity: The Need for Comprehensive Promotion of Healthful Eating, Physical Activity, and Energy Balance" is available online and it details how medical professionals and organizations like the AHA can get involved in the fight against obesity.

The paper rightly reports that rather than target the individual, we need to target the environment in an approach akin to the one taken in the fight against tobacco, and that everyone can play a role.

In an interview the paper's lead author, Dr. Shiriki K Kumanyika had this to say to Medscape's Heartwire,

"The main point of the statement is that we need to place more emphasis on population-based and preventive approaches than we have to date"

"It's inefficient to put all your eggs in the basket of screening and treating the individual"

But perhaps it's Dr. Kumanyika's comments on why this is important to the AHA that I felt were most on the money,

"This statement is about putting the information in one place and telling people who don't think it's their business that the level of advocacy and awareness we need also applies to them. We can't afford to have anyone working on cardiovascular disease who, if asked by the person next to them on the golf course or next to them in the hospital, doesn't really get it that obesity is not just a bunch of people who overindulge."

"We can't afford to have the people who are involved in treatment think that's the only solution. They also have to convince people to do things that are a lot harder, because they're getting right to the heart of how people live, they're getting into vested interests, and there's not necessarily a profit motive. But cardiologists are very, very authoritative and influential people. People will ask their cardiologist for an opinion, and we want them to know what they should say."

I agree wholeheartedly with everything she said and think that the position piece is excellent.

So what was my off the cuffness about at the top of this post?

Well after all that when I look on the AHA's website, under the section entitled, "Diseases and Conditions", despite their call to action on educating the public and professionals about obesity, despite the opening salvo of their position piece,

"Obesity is a major influence on the development of cardiovascular disease (CVD) and affects physical and social functioning and quality of life. The proportion of adults and children who are obese has reached epidemic proportions",

obesity is not listed as a disease or condition important enough to the AHA to highlight on their homepage (click my image above to enlarge).

If the AHA really wants their members to get that obesity is not just about individual overindulgence, how about they come right out on their homepage and declare that it's a chronic disease condition and should be treated with the same degree of concern and respect as diabetes, hyperlipidemia and hypertension as a valid target for both treatment and prevention efforts?

Surprise! Protein's more filling!

Ok, maybe it's not a surprise, but today at least, it's sure going to be news (and perhaps I'll be the first to break the embargo at 12:01AM - thanks Blogger for allowing scheduled posts!).

It's going to be on radio, print and television - the results of the first prong of the DiOGenes study. DiOGenes is a multi-pronged study spearheaded over in Europe and today's spear has to do with trying to answer the question, "What's the best diet to help maintain weight loss?".

This study was an enormous undertaking as it looked at whole families, in 8 different European countries for between 6 and 12 months and randomized their dietary intakes to compare weight gain with diets high or normal in protein and high or low in glycaemic index carbohydrates.

In total, the study aimed

"to recruit a total of around 850 obese/overweight parents (BMI>28) from the 8 participating centres, corresponding to 450 families with an estimated 450-1050 children, where at least one child in each family is overweight."

Mandatory too was an 8 week run-in weight loss phase where adult family members were required to lose 8% of their body weight before their family was admitted into the study.

The results weren't particularly surprising. Dietary protein helped maintain weight loss while GI index did not.

I think the most important part of the whole paper was a quote in the introduction that does a great job explaining why the world's getting so big so fast,

"Given our genetic background, it is essentially infeasible for humans to self-regulate food intake under current environmental circumstances."

What this basically states is that in 2008, the default is weight gain, and I can't agree more. People haven't changed in the past 100 years, but our environment sure has and the reason we're gaining weight so quickly now is that since weight gain is the default, that means by definition maintenance of a healthy body weight in our current environment has actually become a skill. And just like other skills (martial arts for instance), just because your minds' eye might know what it looks like to do a jumping, spinning hook kick, it doesn't mean you can simply jump up and do one.

To extrapolate a martial arts analogy to healthy weight think of it this way: Just because your minds' eye might know what a healthy lifestyle looks like, to expect yourself, without instruction, to be able to simply jump up and happily live with one is often too much to ask (people do it unhappily all the time - that's called dieting).

Not surprisingly this study was funded by Big Food and here's one time where I think it's a great partnership. Here's an opportunity for Big Food to help by using their study to help pave the way to the creation of new food products that may be useful in preventing weight gain/regain.

Hurray for Big Food!

(there's something I don't say very often)

[BTW, I'll likely have a 5-10 second sound bite on CTV's National News tonight in Avis Favaro's story on this study should any of my Canadian readers want to watch]

New Scary Statistics

According to an article in Diabetes Care the number of pregnant women with pre-existing diabetes has doubled in just 6 years.

This was no small study either. The study looked at 175,249 women ages 13-58 years with 209,287 deliveries of 20 weeks gestation from 1999 through 2005.

Back in 1999 only 10% of children born to diabetic mothers were born to moms with pre-existing diabetes (90% were in moms who developed gestational, or during pregnancy, diabetes). By 2005, that number climbed to 21%.

Even more alarming?

The number of diabetic teenagers giving birth rose more than 5 fold.

Yup, diabetic teenagers.

We sure can't call it "adult-onset" any longer. Perhaps we should call it "nutritional" or "weight-related" diabetes?

Another Reason Not to Eat Beef

Assuming of course you care about the environment and are worried about global warming. If you don't and you're not, this post doesn't apply to you.

There's a new word being bandied about to go alongside words like carnivore or vegetarian and that word is locavore and it refers to individuals who strive to eat locally with their predominant rationale being that it'll help the planet to not truck tomatoes in from Mexico or garlic in from Chile.

Strict locavores may limit their dietary choices to foods that come from within a 50 mile radius of where they live. The word (and presumably the practice) has become so trendy as to have been voted the 2007 word of the year by the New Oxford American Dictionary.

Well a study in the journal Environmental Science and Technology says that while indeed eating local does reduce greenhouse emissions, if you're a local carnivore who likes beef, you're probably not helping much.

The researchers estimated that shifting to an entirely local diet would reduce greenhouse gas emissions by the equivalent of driving a hypothetical 1,600km (1,000 miles) less per year.

They also estimated that switching one day's beef meal to anything other than beef would likely have the same impact.

Why?

Because transportation of food apparently only contributes 4% to total food supply greenhouse gas emissions, while production of food contributes 83%.

And what food contributes the most?

Beef. Delicious, bad for you, cancer-inducing, beef. On average beef production contributes 2.5 times more greenhouse gas emissions than those from emitted during the production of chicken or fish.

What's the second worst?

Dairy.

Really want to help the environment?

Become a vegetarian - the study authors estimate that doing so would be the equivalent of reducing greenhouse gas emissions by a hypothetical 12,800 transport kilometres (8,000 miles) per year and this is even if you're not a locavore.

Food for thought?

[Hat tip to loyal blog reader and eagle-eyed Rob]

From the Journal of Duh?

A headline from one of my media trawls caught my eye yesterday, "Fruit and vegetables may help weight loss" and so I clicked the link and found myself face to face with an article discussing a recent paper published in Nutrition Research.

The paper, High intake of fruits and vegetable predicts weight loss in Brazilian overweight adults details the story of 80 overweight Brazilians who attended a nutritional counseling program. Comparing their weight and food frequency questionairre answers from both before and after the 6 month program they found.....

[Drumroll]

People who ate more fruits and vegetables lost more weight.

Why isn't this exciting?

A few reasons.

Firstly because of the study's design. In its analysis it only controlled for age, sex, changes in walking time and total energy intake. No mention of meals out, exercise outside of walking, macronutrient dietary changes, frequency of meals and snacks and many other variables that certainly have a role in weight loss differences.

Secondly because it's not news. Barbara Rolls has dedicated her life's work to the concept of energy density which can be summarized simply in saying eat more foods with lower energy densities (calories per gram) like vegetables and fruits and you'll lose weight.

Thirdly because in the study the weight loss we're talking about in this study is barely weightloss - 3.08lbs over 6 months.

I've seen constipation weigh more than 3.08lbs.

Bottom line?

Eating fruits and vegetables can certainly help with you with weight loss if they are replacing higher calorie options and certainly irregardless of their effect on your weight, they're good for you. But as far as this study goes all it taught me was that I won't be recommending the weight loss program in Brazil that over 6 months only managed to help patients lose a grand total 3lbs and eat a whole 3.5 ounces more fruits and vegetables a day.

More Proof We're Failing

We in this case being a global we.

What are we failing at?

We're failing at ensuring the translation of evidence-based nutrition into easy to understand public education.

So what has been done?

We've allowed Big Food to come into our schools, consultations, dietetic organizations, influence national dietary recommendations and in general use their considerable clout to keep consumers confused to the point of paralysis regarding what's healthy and what's not.

So why am I ranting today?

According to a survey conducted by the international market research firm Mintel, British consumers felt that a food package's "recycling credentials" were more important to them than salt content, sugar content or Calorie content.

Why?

Probably because the average consumer doesn't have a clue how much salt, sugar or Calories they should be consuming and therefore those values on packages are effectively meaningless, whereas recycling information is consumable.

Unfortunately to date, governments, dietetic organizations, and of course Big Food, have been loathe to provide folks with consumption maximums. Instead they've been content to rely on fluffy, wishy-washy statements like, "there are no bad foods", or downright stupid statements like our Food Guide's, "Eat the recommended amount and type of food each day."

How about statements like, "Try not to eat more Calories than you burn" along with a calculator to help you figure out how many that might be, or, "aim for less than 2,000mg of sodium daily", or "aim for less than 50g of sugar daily"

Until we actually educate folks how to interpret a food label with actual recommended maximums, we're really not going to get anywhere.

I suppose one good thing will come of it all and that is apparently our food packages, and hopefully our effectively useless Food Guide, will at the very least end up in their appropriate recycling bins.

Is Thin too Expensive?

I realize that at first glance, that may look like an odd question.

Recent research however, suggests that it might not be.

A recent study, by Pablo Monsivais and Adam Drewnowski published in the December 2007 issue of the Journal of the American Dietetic Organization, looked at the relative cost per calorie of 372 "low energy dense" foods and "high energy dense" foods between 2004 and 2006.

Low energy dense foods would be foods that gram per gram have fewer calories. Fruits and vegetables would be the staples of the low-energy dense shopper.

High energy dense foods gram per gram have more calories and tend to therefore be foods high in fat and/or sugar. This is often the realm of junk food.

Ready for the important and even somewhat surprising results?

Low energy dense foods are much more expensive than high energy dense foods, and while that may not surprise you, the difference in cost may: The least energy dense foods cost $18.16/1,000 kcal as compared to only $1.76/1,000 kcal for foods that were the most energy dense.

Also incredibly important to note, inflation affected low energy dense and high energy dense foods very differently with the 2-year price change for the low energy dense foods being +19.5%, whereas the price change for the high energy dense foods being −1.8%.

So in summary, not only are low energy dense foods far more expensive, their comparative inflation rate over the course of the past two years was 400% higher than the general rate of food inflation and more than 2000% higher than the junkiest of foods.

Put another way, based on a 2,000 Calorie per day diet, if you choose primarily high energy dense foods your Calories will cost you $3.52 a day as compared with a diet consisting primarily of low energy dense foods that will cost you $36.32 a day.

Any wonder why we're getting bigger?

Wanna guess how long it'll be before the government steps in and subsidizes our health food baskets?

Never?

We're in really big trouble.

Interesting TV Show Alert

Airing tonight at 10pm EST on CBC Newsworld's The Lens is a show entitled, "My Big Fat Diet".

My Big Fat Diet chronicles a fascinating experiment whereby a small Canadian community of Namgis First Nations give up their westernized diets for a year and return to their roots eating much more traditional first nation fares.

Basically the entire community goes on Atkins.

What happens next doesn't surprise me, but will sure make for great television and research.

The community loses weight - lots of it. They also get healthier.

The lens has a fabulous website with a tremendous amount of information on the show and if you'd like to watch a clip before tonight, simply click here.

Are You Fated to be Fat?

A study was published last week to a great deal of media fanfare.

The study Evidence for a strong genetic influence on childhood adiposity despite the force of the obesogenic environment, published in the American Journal of Clinical Nutrition, details twin analyses whereby 5,092 twin pairs (some identical, some fraternal) were monitored for weight change. Comparing the weight change over time of identical twins versus those of fraternal twins was used to help determine the degree of nature vs. nurture on weight gain.

The researchers concluded that the vast majority of weight was heritable, or genetic in nature and in their discussion they make a point of noting,

"What is important is this finding means that “blaming” parents is wrong"

I'll come back to that in a moment.

First let's look at North America where roughly 70% of the population is now overweight or obese.

Clearly our genes haven't changed in the past hundred years or so, something the authors of the paper readily agree to.

So if our genes haven't changed yet the study is blaming obesity on our genes, why is it that obesity has become such a concern now?

George Bray perhaps said it best,

"Genes load the gun and the environment pulls the trigger"

So does that mean parents aren't to blame? Their kids have these fat genes and there's nothing we can do about it? They and worse yet their kids are fated to be fat?

No, though blame is a very strong word.

While certainly it's true that the interactions of genes with our obesogenic environment are what's responsible for the rapidly rising weight of the world, given the percentage of folks gaining weight, clearly those genes are pretty darn common. Therefore if you're a parent with however many kids and one or more of them are overweight or obese, at the end of the day does that mean there's nothing you can do about it?

Of course not.

While you can't change the outside environment, certainly your home's foodscape is within your explicit control. You're responsible for the foods in your cupboards, you're responsible for how much viewing time or internet time your children are allowed, and most importantly, you're responsible for both the example you set in terms of eating behaviours and also you're responsible for learning about nutrition, caloric intake and expenditure and healthy living as a whole and you alone are responsible for trying to pass that knowledge on to your kids.

Again, blame is a sharp word and if I'm going to wield it, I like to blame our government and public health systems for not providing parents with the necessary tools to properly understand the impact of the environment on weight nor the skills to maintain a healthy weight within our environment.

Long post short - 100 years ago obesity wasn't a problem; our lifestyles were different, which is why a time machine would serve as a fabulous weight loss aid. Certainly the environment is responsible for changing our lifestyles, however we can certainly still live responsibly within that environment, it just takes education, planning and organization.

The only thing your children are absolutely, for better or for worse predestined to be is related to you. Everything else is modifiable.

Does Diet Pop make you Fat?

Maybe if you're a rat, but even then, only maybe.

The media is going crazy today for a study that looked at rats consuming saccharin (yes, saccharin - a sweetener currently banned in Canada) sweetened yogurt. The study found those same rats later consumed more calories and the researchers postulated that it was a compensatory behaviour.

The media of course has postulated that therefore in humans (a long leap from rats), consumption of diet pop sweetened with aspartame and Splenda (long leaps from saccharin), leads to weight gain.

They also point at the recent study that suggested diet pop drinkers have greater risk for metabolic syndrome, but of course in that study they don't note that drinking diet pop is almost certainly a marker for other eating behaviours which may be more likely to account for the slight increase in risk.

If we look at human studies done on aspartame in weight management one meta-analysis concluded that human studies in fact suggested,

"that replacing (added) sugar by low-energy sweeteners or by complex carbohydrates in an ad libitum diet might result in lower energy intake and reduced body weight. In the long term, this might be beneficial for weight maintenance."

Looking at one study in particular, a randomized trial comparing women who were randomly assigned to consume or abstain from aspartame sweetened foods during a 16-19 week weight loss program followed by 2 years of maintenance showed that,

"The aspartame group lost significantly more weight overall (P = 0.028) and regained significantly less weight during maintenance and follow-up (P = 0.046) than did the no-aspartame group."

My take on the rat study?

If the researchers fed the rats low to zero calorie meals by means of artificial sweeteners, it would not be surprising for those animals' bodies to note the lack of calories and compensate later in the day in a normal response to a low-calorie meal. Put simply, they compensated because they got hungry.

Of course, that's not how people tend to use sweeteners, and certainly not how I would recommend that they be used. People tend to use sweeteners to eliminate excess calories, generally liquid calories, but of course still consume sufficient calories from their meals to register that they've eaten. Therefore their bodies don't generate excess hunger, don't compensate later in the day and do avoid the excess liquid calories that they have replaced.

Long story short, I wouldn't throw out your diet pop just yet but don't have just it for breakfast.

Lose Weight by Osmosis

Today I'm going to talk about a study that I had thought of doing and now clearly don't have to.

It's about something I've termed, "osmotic weight loss"

Simple study - 357 husbands and wives weighed themselves and completed self-reported food and lifestyle inventories at the onset of an intensive lifestyle intervention and 12 months later. They then compared these with the same data from a control group of 357 husband and wife teams at the beginning and end of a diabetic education program. The catch is, only one member of the husband and wife teams was actually enrolled in the weight loss, or diabetes education, programs.

The untreated spouses at 12 months also completed a questionnaire detailing the number of high and low fat foods in the home, the number of snack foods in visible locations and something called the Exercise Environment Questionnaire.

The results?

Untreated spouses in the diabetes program lost 0.19% of their starting body weight while the spouses from the intensive lifestyle intervention weight loss program lost 2.7% of their starting weights. The untreated weight loss spouses also reported decreased availability and access to high-fat and snack foods in their homes. Exercise wise, there was no difference.

So what does this teach us? Lifestyle interventions affect more than simply the program participant. The reason I wanted to do this study was the simple fact that I observe the same phenomenon constantly in my patients' families.

The next study I'd like to see would be a comparison of osmotic weight loss between different weight loss programs and approaches.

My hypothesis would be that less sustainable approaches (all liquid diets, heavy use of supplements, highly restrictive approaches, etc.), would not share a spousal osmotic relationship perhaps due to the non-enjoyable and non-sustainable nature of the participants' interventions.

Remember, unless you actually enjoy your lifestyle as you lose your weight, you're liable to gain it back and here clearly if you in fact do enjoy your lifestyle, others around you might well take notice and learn from your successes.

Osmosis works.

Don't Blame the Escalator

Today kicks off a week from NAASO (The Obesity Society) as I'm writing from New Orleans where they're having their annual scientific assembly. Every year I come to this conference I'm amazed at the incredible amounts of brains and passion that are being poured into obesity research worldwide. The conference is enormous and boasts over 2,000 attendees from the four corners of the world.

This week I'm going to try to highlight some of what I feel are among the conferences most interesting presentations and studies.

The first takes us to Nigeria - rural Nigeria in fact, where Lara Dugas and her colleagues went to study the effects of the energy expended in daily activity on weight gain. They followed 153 rural Nigerian women (over 20% of them subsistence farmers) and measured their total daily energy expenditures (the total calories they burned all day long), their resting daily energy expenditures (the calories they burn at rest) and then inferred the calories they burned through daily activity.

They then compared the data from rural Nigeria with the same data taken from a group of women from urban Chicago (where over 50% of them were unemployed).

They then followed these women for 3 years.

Some of the results were not surprising.

The Nigerians were much lighter - average weight was 128lbs and BMI of 23.1 vs. those from urban Chicago where average weight was 184lbs and BMI of 31.

Here's the surprising result.

Calories burned through daily activity did not differ between the skinny rural Nigerian subsistence farmers and the obese unemployed urban Chicagoans.

Come again? The subsistence farmers and the unemployed urbanites burned the same number of daily Calories in activity? Haven't we been blaming obesity at least partially on the poison fruits of development? Aren't dish washers, escalators, cars, and elevators stealing our Calories away from us? Shouldn't the skinny Nigerian farmers be burning far more Calories? Isn't that part of why they're so skinny?

I sure would have thought so - and from the reactions in the room, so did most other folks.

Second non-surprising result?

No measure of energy expenditure, not resting, total or that from activity, was associated with weight change in either group over the 3 years and in fact, the rate of change in body weight over the 3 years was virtually identical in Nigeria and Chicago.

Why isn't that surprising? What that result says is that the Calories you burn don't dictate your weight and that instead what dictates your weight are the Calories you consume. The only surprise here is the fact that rate of weight gain is the same in rural Nigeria vs. urban Chicago where one might have thought greater access to high Calorie foods would have led to a dramatically more rapid gain in Chicago (though I should note, the Chicagoans had higher total energy expenditures as a consequence of their higher weights and consequently for them to gain weight at the same rate as the Nigerians does in fact necessitate eating more, just not tons more).

So if you take these results as valid (and it really was a very well designed study), they basically conclude that the environment as it pertains to activity, doesn't matter, that you can't blame the escalators, and shocker of all shockers (there's the sarcasm), energy intake matters far more than energy output in the establishment of obesity.

Duh!

Yesterday saw the most expensive, "Duh!" moment I've seen in a long time.

Yesterday the UK Government's think tank Foresight published a study that involved over 250 experts that concluded,

"The technological revolution of the 20th century has led to weight gain becoming inevitable for most people, because our bodies and biological make-up are out of step with our surroundings"

Gee, ya think?

You mean people aren't trying to become overweight? It's not just one gigantic social experiment gone awry whereby the entire world, every person in every single country on the planet, has colluded to flummox scientists by willfully trying to gain weight for the past 50 years?

Wanna read the bullet points that summarized the whole of their 2 year long, 250 expert advised, so damn big it crashed my browser trying to download it, work?

Most adults in the UK are already overweight. Modern living ensures every generation is heavier than the last – `Passive Obesity’.

By 2050 60% of men and 40% of women could be clinically obese. Without action, obesity-related diseases will cost an extra £45.5 billion per year.

The obesity epidemic cannot be prevented by individual action alone and demands a societal approach.

Tackling obesity requires far greater change than anything tried so far, and at multiple levels: personal, family, community and national.

Preventing obesity is a societal challenge, similar to climate change. It requires partnership between government, science, business and civil society.

Brilliant! Earth shattering! Ground breaking!

Anyone want to venture a guess how much this report must have cost?

If there are other governments out there thinking about putting together experts and spending gajillions of dollars researching this - I'll do it for half price and it'll be on your desk in the morning.

Big Beverage Fizzes their Pants

Big beverage is going to be all over this one.

This week the British Medical Journal published what the press is referring to as disappointing results for a school-based childhood obesity intervention.

The intervention, commonly referred to as the, "Ditch the Fizz" campaign involved giving 7-11 years olds 4 one hour sessions encouraging them not to drink carbonated beverages.

In the original study, the intervention reduced carbonated beverage consumption in the intervention group by 0.6 glasses per day and that group after one year showed only a 0.1% increase in obesity while a control group showed a 7.5% increase.

Well guess what, three years later and all the differences are gone between the groups.

Now for these results to be disappointing, I would argue they'd have to be surprising.

So are they surprising?

Good lord no.

So basically there was a public health intervention encouraging kids not to drink soda pop. That's it. No talk of calorie awareness, restaurant calorie contribution, juice equivalency to soda in terms of calories, no teaching of hunger prevention skills and somehow there was an expectation that asking kids who are 7 to drink less soda pop would translate into a sustained long-term weight reducing outcome?

Even if you want to accept the researchers null hypothesis that a decrease in soda consumption is in and of itself sufficient to change childhood obesity rates longterm, I have to wonder, do the researchers have kids? Do they know the attention and retention span of 7-11 year olds? 3 years later and they're expecting their 4 hour intervention to ask kids to drink less soda, soda that the kids might well describe as "awesome", soda that's promoted to the kids in commercials starring some of their most beloved sports and entertainment icons, to have had a lasting impact on those children's soda consumptions?

You've got to be kidding.

Good thing for the researchers I wasn't reviewing their grant application.

You can bet Big Beverage is going to run with this one.

Don't Eat at Wendy's Part III

I suppose this is becoming a series all by itself.

In an article published recently by the American Journal of Public Health, one of my favourite nutritional researchers and authors, Marion Nestle, examined the responses of Burger King, McDonald's and Wendy's to the past 8 years worth of increasing calls to action on obesity in the form of their portion sizes of soda, French fries and hamburgers from 1998 through 2006.

The expectation might be that given the public and medical uproar with regards to growing rates of obesity, and the clear involvement of fast food and fast food portions as factors in that rise, that perhaps we might have expected to see decreases in fast food portions.

To summarize her findings, McDonald's in fact has reduced some of their portion sizes, though they're still in the neighbourhood of 500% larger than those they had when they opened in 1955.

Wendy's on the other hand, ah Wendy's.....let's start with fountain sodas.

In 1998 Wendy's Smalls were 16oz, Mediums 22oz and Biggie's were 32 oz.

In 2006 Wendy's Smalls were 20oz, Mediums 32oz and Large (Biggie's gone) was 42oz.

Next we'll move onto French fries.

In 1998 Wendy's Smalls were 3.2oz, Mediums were 4.6oz, Biggies were 5.6 oz and Great Biggies were 6.7oz.

In 2006 Wendy's Smalls were 5oz, Mediums were 5.6oz and Large were 6.7oz.

Burgers, probably because the base costs are higher for beef than for soda or fries, haven't changed.

Do you remember an advertising campaign that mentioned that their sizes had increased across the board for fries and drinks?

I sure don't.

Yet another reason to add to the growing list of reasons not to give Wendy's your fast food dollars.

For those not familiar with the list, to summarize:

Wendy's seemingly lies to you, apparently thinks you're stupid and continues to increase portion sizes without telling you using descriptive adjectives that might have you believe that in fact you're eating less ("I'm not having their old Biggie, just a Large").

A Calorie's a Calorie, or is it?

Certainly that's what we preach. A calorie's a calorie - if you were to eat the exact same number of calories daily it wouldn't matter where those calories came from they'd have the same effect on your weight.

Or would they?

I'm very comfortable saying I'm wrong, and while I'm not quite willing to do that in the a calorie is a calorie case yet, I'm a bit closer today due to an article I read yesterday in the journal Obesity.

The article looked at 42 green monkeys who were followed for 6 years. They were fed one of two diets that were designed to "maintain" their study starting weight by providing them each with 70 Calories per kg of green monkey weight. What varied in these diets was the percentage of fat that came from trans fats with one group of monkeys getting 8% of their fat from trans fat sources while the other group had less than 1% of fat from trans fat sources.

Otherwise, the sample diets were pretty much the same.

The results were surprising. The trans fat group's weight increased by roughly 7% while the other group gained less than 2% with the trans fat group having gained more fat intra-abdominally (the less healthy place to gain it). The researchers also found that post meal insulin levels in the trans fat group were 3x higher than in the non-trans fat group and there was a reduction seen in tissue biopsy of the trans fat group's insulin receptors' abilities to trigger a response.

The authors conclude that trans fats are in fact independently associated with both weight gain and the preferential distribution of weight intra-abdominally resulting in an impairment of glucose tolerance which in turn is of course a risk factor for the development of type II diabetes.

This was definitely a neat study and while I'm not yet ready to stop telling people a calorie's a calorie, I'm eager to see some studies that try to tease out whether this is applicable to humans or just to green monkeys.

To be sure however, this study is yet one more piece of damning evidence against the inclusion of trans-fat in our diets.

McCarrots?

No, McCarrots don't exist, but if they did, you're kids would be more likely to eat them.

In a study published this month in the Archives of Pediatric Adolescent Medicine we can see proof of the vulnerability of children to advertising.

The study had children taste 5 pairs of identical foods and beverages in packaging from McDonald's and in matched but unbranded packaging and were then asked which one tasted better.

Bet you can see where this is going.

The participants by the way were between the ages of 3 and 5 years old. The foods were McDonald's hamburgers, McDonald's fries, a Chicken McNugget, 3 ounces of 1% milk and baby carrots.

Yes, even carrots wrapped up in McDonald's wrappers were rated as tasting better by this group of children.

As far as I'm concerned there should absolutely be a ban on advertising targeting children and given a child's proven inability to discern truth from advertising that ban should extend beyond simply junk food advertisers but rather to all advertisers. This elegant study certainly confirms that need.

It also makes me wish McDonald's sold baby carrots.

Obesity is "socially contagious"

The media will be all over this one.

A study came out today in the New England Journal of Medicine that showed that over a 30 year period people's weights were strongly influenced by the weights of their friends and spouses.

The study followed over 12,000 folks and mapped their weights against their "social networks".

Their research states:

If your spouse becomes obese, your chance of becoming obese rises by 37%

If your adult sibling becomes obese, your chance of becoming obese rises by 40%

If you're a man and your male friend becomes obese, your chance of becoming obese rises by 100%

Don't worry if your neighbours are obese

Don't worry if your opposite sexed friend is obese

Don't worry if you're a woman and your female friends become obese

It's actually a beautifully put together study - from the writing, to the methodology, to the gorgeous diagrams and slick video on the New England Journal website that demonstrates the social march of obesity over time.

So is it important? Does it tell us anything we don't already know?

I don't think so.

Friendships and marriages tend to be forged over commonalities, over shared pleasures.

What am I getting at?

Marathon running teetotaling vegans are far more likely to be friends with marathon running teetotaling vegans than they are with sedentary, beer swilling carnivores and they're probably alot less likely to marry them too.

I think what this study proves beautifully is that lifestyle dramatically impacts upon weight and that friends and spouses dramatically impact upon lifestyles.

So does this study help with prevention and treatment?

The authors think so,

"The relevance of social influence also suggests that it may be possible to harness this same force to slow the spread of obesity. Network phenomena might be exploited to spread positive health behaviors"

I guess what they're getting at is that skinniness may also be socially contagious if harnessed by social networks. Good news is, if the researchers want to, they can simply apply their same statistics and formulae to examine the effects of weight loss in social networks....only problem there is that sustainable weight loss for the most part is a pretty elusive beast.

Bottom line - your friends and spouses likely share your lifestyle more than your neighbours and coworkers, and your lifestyle obviously has a dramatic effect on your weight.

What this study should spur you to do is examine how you spend time with your friends and family. If socializing means going out to dinner all the time or hitting the bars, maybe you can suggest trying some less calorie dense, or even some calorie burning activities.

What this study should not spur you to do is put a sign outside your door that says, "You must be this thin to be my friend".

Will Diet Coke make you fat?

Splashed over headlines and sound bites today will be articles and reports telling you that a new study suggests that if you drink any soft drinks, even diet ones, that your risk of developing high blood pressure, high cholesterol, diabetes and obesity rises dramatically.

Scary stuff, maybe you should immediately pitch your diet coke stash.

Don't throw out it out yet.

So this study, published yesterday in Circulation, looked at over 6,000 folks and their soft drink consumption with the authors reporting that they controlled for age, sex, physical activity index, smoking, saturated fat consumption, trans fat consumption, fiber, magnesium, total calories and glycemic index in asking whether or not consuming soft drinks (diet or otherwise) raised the risk of developing metabolic syndrome (the constellation of symptoms listed above).

The authors concluded,

"In middle-aged adults, soft drink consumption is associated with a higher prevalence and incidence of multiple metabolic risk factors"

and they found this to be true regardless of whether the soft drinks were of the regular or diet variety.

Problem is, there are too many inconsistencies and omissions in this study for it to have any value. Let's go through some of them:

They don't tell us how they tracked calories. They mention controlling for calories in their abstract but then fail to mention in their methodology how exactly they determined how many calories folks in this study were consuming. That's quite an important methodologic piece as if it turns out that folks who drink soft drinks (diet or otherwise) tend to consume more calories, it'll matter how they tracked calories since it's calories that lead to weight gain and weight that leads to metabolic syndrome.

The calories they did track are inaccurate. They reported that folks who drank no soft drinks consumed on average 1,800 calories daily and those drinking 2 or more daily 2000 or so Calories. In what alternate universe is the average per capita consumption of calories in America 1,800-2,000 calories daily? According to the USDA, the average American consumes around 2,700 calories daily and even back in 1970 was still higher than the calories reported in this study. The Food and Agriculture Organization of the United Nations actually thinks the average American consumes around 3,770 calories daily. Clearly if this study's calorie models are flawed, with calorie models based off of reported dietary intakes than dietary intakes are flawed in which case the conclusions aren't valid.

The authors did not control for type of carbohydrates. They kind of did, indirectly, by controlling for glycemic index, but frankly a more valuable control would be for whole grain consumption as its consumption has been shown quite conclusively to minimize the risk of developing metabolic syndrome while the converse is true from refined carbohydrates (the white stuff)

The authors did not control for sodium intake which of course would impact on the development of hypertension (one of the criteria above). Here actually is an argument that might be applicable as many diet beverages do still have salt in them

The authors did not control for meals out. If would certainly seem plausible to me that the folks drinking more soft drinks (diet or otherwise) are the folks eating out more regularly. Meals out have more calories and as a whole more dietary salt, less healthy fats and more refined carbohydrates - all of which contribute to metabolic syndrome development.

The authors could not come up with any commonality to explain the fact that diet soft drink consumption and regular soft drink consumption led to the same outcomes. Unfortunately, without commonality what they've failed to prove is causality and instead have proved association. They did mention "sweetness" of the beverages as a possibility leading people to consume more, but if you remember back to my criticisms on the study's calorie models, they concluded that in fact calories were not statistically different between groups. As well, if they did want to blame sweetness, another control would have to be juice consumption, because if both high fructose corn syrup and aspartame can have the same effect, so too should plain old fructose.

So to sum up, the study's calorie models are flawed at best, the authors didn't control for known confounding variables that have in fact been proven to be contributors to metabolic syndrome and they admit that they can't think of any similarities between diet soft drinks and regular soft drinks that would explain their results.

The ABA (the American Beverage Association) came out with a statement of their own and amazingly, I agree with their conclusions more than this study's.

The ABA states,

"This study doesn't prove any link between soft drinks and increased risk of heart disease. Its assertions defy the existing body of scientific evidence as well as common sense. Even the researchers acknowledge that their study can't support a link."

I couldn't (and didn't) say it better myself.

You may now enjoy your Diet Cokes.